To the list of small businesses that may have trouble surviving the coronavirus, add independent mental health providers. This, at a time when everyone is dealing with an uncommon level of emotional stress.
Mental health practitioners deliver services in what new research is showing constitutes an ideal environment for spreading COVID-19. Because of the way these practitioners are paid, it’s likely they will have little choice but to keep delivering these services in an environment that endangers themselves and patients.
The format of a therapy session is well-known: patient and therapist talking in an office.
Most therapists work in small offices. Mine is 80 square feet. Windows usually don’t open. Patient encounters are far from brief. Patients sometimes cry. Sometimes they shout. They always talk and breathe.
Our rapidly changing knowledge of COVID-19 has demonstrated that a major factor in the spread of the disease is the droplets we expel when we talk or even exhale. Add prolonged contact in offices with no air exchange plus minimal social distancing plus asymptomatic patients and/or therapists. It equals a petri dish for coronavirus.
In the good old days – just months ago – these practice environments were no problem.
When the crisis hit, thanks to the leadership of our governor, Human Services Secretary David Scrase, the N.M. Superintendent of Insurance and Presbyterian, action was swiftly taken to ensure continuity of care for our patients. To reduce transmission, insurance began paying for sessions by phone – that hadn’t been allowed. Telehealth rules were relaxed so common communications products like Skype could be used to conduct sessions.
These were smart decisions. But these measures are temporary, in place only for the duration of the crisis. One insurer told me they expected these emergency measures to end. … Then it’s back to small, poorly ventilated room for hours-long conversations.
Except maybe not. Patients are increasingly reporting they do not feel safe returning to office settings.
I am part of a group practice. As essential workers, our office could remain open. In March we decided to give our patients the option of coming in or doing sessions electronically. About half of us, including me, are practicing from our homes, by phone, or telehealth when possible. In the office, both patients and therapist wear masks; therapists sanitize their offices and maintain social distance. Procedures were put in place to keep our waiting room and the reception process safe. But there isn’t much we can do about the air quality or potential viral overloads in these spaces, especially over a prolonged period of time.
This is the concern: Many patients say that even with proper sanitation and mask wearing, they don’t want to return to face-to-face visits in a confined room where people have been going in and out of all day.
What to do?
We could reduce some risk by limiting the total number of face-to-face sessions. But that doesn’t speak to the safety of each individual.
Telehealth could be a required benefit in all, not just some insurance policies. Telehealth’s electronic requirements could be eased to allow for cheaper and easier access to this treatment modality, but is that a good thing? I don’t think so. Skype, etc. isn’t privacy protected.
The most sensible solution is to continue to reimburse land-line and cellular telephonic therapy sessions. While privacy on a phone call cannot be guaranteed 100%, it is way more secure than internet protocols in common use.
Should phone sessions replace face-to-face sessions? No. But they should be an insurance-reimbursable option until a vaccine is available or until science-based evidence supports resuming office visits.
The views expressed in this article are entirely the author’s alone.